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Blood pressure variability during pediatric cardiac surgery is associated with acute kidney injury
Jennifer E Fishbein1, Matthew Barone2, James B Schneider3
1Department of Pediatrics, Cohen Children's Medical Center, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA.
Insights
High blood pressure variability (BPV) during pediatric cardiac surgery is linked to acute kidney injury (AKI) in infants. This suggests BPV may be a modifiable risk factor for AKI in this vulnerable population.
Area of Science:
- Pediatric Cardiac Surgery
- Nephrology
- Critical Care Medicine
Background:
- Blood pressure variability (BPV) is linked to adverse outcomes in acute care.
- Acute kidney injury (AKI) is a frequent and severe complication following pediatric cardiac surgery with cardiopulmonary bypass (CPB).
- The association between intraoperative BPV and AKI development in children undergoing CPB has not been previously studied.
Purpose of the Study:
- To investigate the relationship between intraoperative blood pressure variability (BPV) and the incidence of acute kidney injury (AKI) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).
- To explore the association of BPV with other postoperative outcomes, including length of stay and mechanical ventilation.
Main Methods:
- Retrospective chart review of pediatric patients undergoing cardiac surgery with CPB.
- Intraoperative BPV was quantified using average real variability (ARV) and standard deviation (SD).
- Multiple regression models were employed to assess the association between BPV and AKI, as well as other clinical outcomes.
Main Results:
- Of 231 patients, 51.5% developed AKI. Higher systolic and diastolic ARV were associated with AKI development (OR 1.40 and 1.4, respectively).
- Increased diastolic SD correlated with longer PICU stays (β 0.94).
- In infants (≤12 months), greater systolic ARV and SD were linked to AKI, whereas no significant association was found in older children (>12 months).
Conclusions:
- Elevated BPV during CPB in pediatric cardiac surgery is associated with postoperative AKI in infants.
- BPV emerges as a potential, modifiable risk factor for AKI in this high-risk pediatric population.
- Further research is warranted to explore interventions aimed at mitigating BPV to prevent AKI.
Background:
Blood pressure variability (BPV), defined as the degree of variation between discrete blood pressure readings, is associated with poor outcomes in acute care settings. Acute kidney injury (AKI) is a common and serious postoperative complication of cardiac surgery with cardiopulmonary bypass (CPB) in children. No studies have yet assessed the association between intraoperative BPV during cardiac surgery with CPB and the development of AKI in children.
Methods:
A retrospective chart review of children undergoing cardiac surgery with CPB was performed. Intraoperative BPV was calculated using average real variability (ARV) and standard deviation (SD). Multiple regression models were used to examine the association between BPV and outcomes of AKI, hospital and intensive care unit (PICU) length of stay, and length of mechanical ventilation.
Results:
Among 231 patients (58% males, median age 8.6 months) reviewed, 51.5% developed AKI (47.9% Stage I, 41.2% Stage II, 10.9% Stage III). In adjusted models, systolic and diastolic ARV were associated with development of any stage AKI (OR 1.40, 95% CI 1.08-1.8 and OR 1.4, 95% CI 1.05-1.8, respectively). Greater diastolic SD was associated with longer PICU length of stay (β 0.94, 95% CI 0.62-1.2). When stratified by age, greater systolic ARV and SD were associated with AKI in infants ≤ 12 months, but there was no relationship in children > 12 months.
Conclusions:
Greater BPV during cardiac surgery with CPB was associated with development of postoperative AKI in infants, suggesting that BPV is a potentially modifiable risk factor for AKI in this high-risk population.
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